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Comment by 7Z7 | Hacker News Reader

From reddit:

Clarification here, CVS cut the retail price of the existing generic for Adrenaclick (known as Epinephrine).

This generic has been around for a while, but isn't an A/B rated generic so it's illegal for a pharmacy to dispense this if a prescription is written for EpiPen. We can dispense this if a prescription is written for Adrenaclick or Epinephrine.

Make sure your doctor writes a script for Adrenaclick or it is illegal for us to dispense this cheaper generic to you

Edit: The injection device of each product is what limits the A/B rating. Adrenaclick and EpiPen have different autoinjector systems. Yes the regulations are that strict. Here's[0] a video showing the difference between Adrenaclick, Epipen, and AuviQ (which has been recalled and discontinued).

[0] https://www.youtube.com/watch?v=LRgqwgCh4Fs

https://www.reddit.com/r/news/comments/5njj2x/comment/dcbyju...

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That was a very interesting video. Why was the AuviQ withdrawn?

Quality Control issues. There's an interesting post about the whole Epipen fiasco here: - http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-dr...

The author's first comment (the first response to the first comment) is (to me) also interesting...

That's kind of a fun juxtaposition there. A product withdrawn because it didn't work and a rant about complex regulation of products that consumers expect to be 100% reliable.

And the FDA was right to withdraw it. But the only reason it was around in the first place was that it was a sophisticated but also relatively complicated improvement on the EpiPen. It's Europe's 8 different brands that are basically just as simple as an EpiPen that the author really wants in the US.

Bridgewater, NJ - Sanofi US is voluntarily recalling all Auvi-Q® (epinephrine injection, USP). The recall involves all Auvi-Q currently on the market and includes both the 0.15 mg and 0.3 mg strengths for hospitals, retailers and consumers. This includes lot numbers 2081278 through 3037230, which expire October 2015 through December 2016.The products have been found to potentially have inaccurate dosage delivery, which may include failure to deliver drug.

http://www.fda.gov/Safety/Recalls/ucm469980.htm

> which may include failure to deliver drug

The way this sounds it's not mechanical but a software bug. How interesting. I'd love it if someone did some RE on these and found their failure mode.

> The way this sounds it's not mechanical but a software bug.

To me that sounds very much like a mechanical bug - the delivery mechanism failed. How much software do these things have in them, anyway?

Watch the video and you'll see. The thing has a lot of scripted audio files and seems like it has a beefy battery.

> How much software do these things have in them, anyway?

Any answer other than "fucking zero" would be terrifying. I'm not risking my life on some guy properly writing a software module (says the guy driving a car to work this morning)

Huh! So we had an affordable solution all around but it was illegal ?

No, it was not illegal.

Marketing and consumer behavior contributed to people not seeking out the cheaper option.

It was illegal. By law CVS could not prescribe the generic Adrenaclick in place of the EpiPen, if the prescription was for an EpiPen.

Classic case of the government causing abusive artificially high prices for consumers through bad regulation.

First, pharmacies don't prescribe anything, they dispense medication. Second, if you voiced how expensive EpiPens are to your pharmacist they would not only recommend the generic, but (so long as they're not swamped) call your doctor right there at the desk to get the prescription changed.

The government's position might be considered overly cautious but I agree with it in this case, the two injectors are sufficiently different that they're not drop-in replacements for each other.

Every pharmacist and, moreover, every consumer capable of conducting a transaction with said pharmacists is also capable of spending the two minutes* required to evaluate the difference between these two auto injectors.

Evaluating the distinction doesn't require anything close to an advanced degree but it's not legal for anyone who isn't credentialed to vend/dispense/trade/exchange/grant/supply/provide the still-very-effective, much cheaper alternative based solely on the customer's informed demand--doing so would be "illegal".

Yes, if your highly-trained, well-payed, in-demand pharmacist has the time and interest; they can work through the call tree until he reaches your highly-trained, well-payed, in-demand doctor; who would've wrote a more general prescription in the first place if it didn't increase their chances of being sued, and get the prescription changed. The problem is, apparently, that hasn't happened often enough--probably because it doesn't happen for free. Someone ends up paying for it e.g., the doctor and pharmacologist, other patients, the insurer and their other clientele or the tax payer--multiplied times however many epinephrine injectors are sold in a given year.

There are few incentives to economize in the chain of payers because health-care is an unlimited 'right' that should be provided for by someone (everyone) else: https://en.wikipedia.org/wiki/Tragedy_of_the_commons

* Link from above: https://www.youtube.com/watch?v=LRgqwgCh4Fs

Honestly even if they are different what matters to me is whether the difference is worth $$$$$.

The government certified highly trained doctor seems to have simply overlooked that a cheaper and almost as good alternative existed!

I read the other comment as thinking that generic Adrenaclick (the low cost alternative) was illegal. It wasn't.

A prescription written for Epipen still can't be filled with generic Adrenaclick, so "was illegal" isn't a great description of that situation. It's hardly complicated to ask a doctor to write a different prescription, so that's why I talked about consumer behavior and marketing. Given that the different mechanisms require different training, I am somewhat forgiving of the "as written" requirement for auto-injectors.

So it was not EpiPen that was fleecing people but people enamoured by marketing strategies wanted to pay 10x more ?

4x.

By volume, it was mostly insurance or non person entities (school systems and the like, by gov mandate) that paid for it. Of course when insurance pays everyone pays through their premiums, but that's where the consumer behavior comes in, who cares what it costs if it is covered.

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